Provider Demographics
NPI:1568120871
Name:VALDEZ VILLEGAS, JAZMIN (OTA)
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:VALDEZ VILLEGAS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 W 86TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-4662
Mailing Address - Country:US
Mailing Address - Phone:785-554-8288
Mailing Address - Fax:
Practice Address - Street 1:9701 MONROVIA ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-1564
Practice Address - Country:US
Practice Address - Phone:913-492-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-05610224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant